Pulmonary Contusion and Ventilator Management

• Pulmonary contusion is the most common injury in blunt thoracic trauma.
• Patients with pulmonary contusion often present with hypoxia, hypercarbia and increased work of breathing.
• Importantly, patients with pulmonary contusion have a low cardiopulmonary reserve.  Maintain a low threshold for initiating mechanical ventilation is these patients.
• When starting mechanical ventilation, think about the following:
  • Patients are at high risk for developing ARDS
  • Most centers use a low tidal volume ventilatory strategy
  • Higher levels of PEEP may be necessary to recruit collapsed alveoli
  • High frequency oscillatory ventilation (HFOV) and airway pressure release ventilation (APRV) are modes of ventilation that are gaining in popularity for ventilating patients with pulmonary contusions.

References

Kiraly L, Schreiber M. Management of the crushed chest. Crit Care Med 2010; 38(S):S469-S477.